General practitioners prefer prescribing indicators based on detailed information on individual patients: a Delphi study
- 131 Downloads
To assess the face validity of both simple and advanced quality indicators for prescribing in general practice.
In a three-round Delphi study, 100 randomly selected general practitioners (GPs) in Denmark rated 18 indicators for prescribing of non-steroidal anti-inflammatory drugs. All indicators were based on prescription register data and focused on different prescribing aspects. Advanced indicators contained information at the patient level, viz. age, sex and history of drug use, while simple indicators only used drug statistics at practice level. Indicators were rated on a nine-point Likert scale. Consensus among GPs was defined as interquartile ranges of three or less. A median rating of 7–9 was interpreted as face validity and a median rating of 1–3 as no face validity.
Participation in the study was accepted by 44 GPs and 37 completed all three rounds. Three indicators based on patient level data and focusing on adverse effects were assessed to have face value. One indicator focusing on costs and based on practice level data was considered unsuitable for evaluating the quality of prescribing. Consensus was not reached for the remaining indicators.
GPs do not regard simple indicators based on aggregated data at practice level as suitable for evaluating the prescribing quality in general practice, but prefer indicators that rest on clinical data at the patient level.
KeywordsPrescribing indicators Quality of prescribing Delphi technique
- 11.Glintborg D, Unkerskov J, Bach KF, Rasmussen H, Kampmann JP (2002) [NSAID—controversies]. Rationel Farmakoterapi 8:1–4 (in Danish)Google Scholar
- 15.Hawkey CJ, Karrasch JA, Szczepanski L, Walker DG, Barkun A, Swannell AJ, et al (1998) Omeprazole compared with misoprostol for ulcers associated with non-steroidal anti-inflammatory drugs. Omeprazole versus Misoprostol for NSAID-Induced Ulcer Management (OMNIUM) Study Group. N Engl J Med 338:727–734CrossRefPubMedGoogle Scholar
- 16.Yeomans ND, Tulassay Z, Juhasz L, Racz I, Howard JM, van Rensburg CJ, et al (1998) A comparison of omeprazole with ranitidine for ulcers associated with non-steroidal anti-inflammatory drugs Acid Suppression Trial: Ranitidine versus Omeprazole for NSAID-Associated Ulcer Treatment (ASTRONAUT) Study Group. N Engl J Med 338:719–726CrossRefPubMedGoogle Scholar
- 17.Lewis SC, Langman MJ, Laporte JR, Matthews JN, Rawlins MD, Wiholm BE (2002) Dose–response relationships between individual nonaspirin non-steroidal anti-inflammatory drugs (NANSAIDs) and serious upper gastrointestinal bleeding: a meta-analysis based on individual patient data. Br J Clin Pharmacol 54:320–326CrossRefPubMedGoogle Scholar
- 20.Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, van het Loo M, et al (assessed December 2002) The RAND/UCLA Appropriateness Method User’s Manual. http://www.rand.org/publications/MR/MR1269/
- 22.Cantrill JA, Sibbald B, Buetow S (1996) The Delphi and nominal group techniques in health services research. Int J Pharm Pract 4:67–74Google Scholar